21 ve 22 G EBUS TBNA İğnelerinin Mediastinal ve Hiler LENF nodları Tanısal Değerinin karşılaştırması

Yıl 2020, Cilt: 4 Sayı: 3, 226 - 229, 29.10.2020

Hulya Dirol Ruşen Uzun Canan Sadullahoğlu

https://doi.org/10.30565/medalanya.728239

Öz

Amaç: EBUS TBNA intratorasik lenf nodları için önemli bir tanısal işlemdir. Örnekleme için 21, 22 ve 25 G iğneler kullanılır. 21 G iğnenin iç çapı daha geniş olduğu için daha iyi örneklerin alınması beklenir. Halbu ki, 21 ve 22 G iğneleri kıyaslayan çalışmaların sonuçları çelişkilidir.

Yöntem: Çalışma grubu, 21 G (Grup 1; n=40) ve 22 G (Grup 2; n=40) iğne kullanılarak EBUS TBNA yapılmış hastalardan oluşmuştur. Hasta verileri retrospektif olarak analiz edilmiştir. Tüm örneklemlerde ROSE uygulanmıştır.

Bulgular: 21 G iğnenin sensitivite, spesifite ve tanısal doğruluğu sırasıyla %95, %85 %93 idi. 21 G iğnenin tanısal doğruluğu 22 G iğneye göre daha yüksek idi (93% karşı %80). 22 G göre 21 G iğne ile yapılan işlemde, tanı için daha az örnek yeterli oldu (r=0.03, p<0.05).

Sonuç: 21 G iğnenin tanısal doğruluk oranı, 22 G iğneden daha yüksekti. Bu sonuca göre, 21 G iğneyi tercih etmek daha iyidir. 21 G iğne ile 22 G iğneye göre, daha az sayıda örnek tanı için yeterlidir. 21 G iğne ile elde edilen daha az örnekle teşhis imkanı, ROSE yapan sitopatoloğa zaman avantajı sağlayabilir. Bu avantajdan dolayı ROSE yapılan EBUS TBNA'da 21 G iğneye öncelik verilebilir.

Anahtar Kelimeler

Endobronşiyal ultrason kılavuzluğunda transbronşiyal iğne aspirasyonu (EBUS-TBNA);, Hızlı Yerinde Değerlendirme (ROSE);, 21 Gauge İğne;, 22 Gauge İğne

Comparison of 21 G and 22 G EBUS TBNA Needles Diagnostic Value in Mediastinal and Hilar Lymph Nodes

Öz

Aim: EBUS TBNA is an important diagnostic procedure for the intrathoracic lymph nodes. 21 G, 22 G and 25 G needles are used for sampling. Better samples can be expected to be taken via 21 G needle, as the inner diameter of 21 G needle is larger. However, the results of the studies comparing 21 G and 22 G needles are controversial.

Methods: The study population consists of patients with EBUS TBNA performed via 21 G needles (Group 1; n=40) and the patients for whom 22 G needles used (Group 2; n=40). The data of patients were retrospectively analyzed. ROSE was performed for all samples.

Results: The sensitivity, specificity and diagnostic accuracy of the procedure with 21 G needle was 95%, 85%, 93%, respectively. The diagnostic accuracy of 21 G needle was found to be higher than that of 22 G needle (93% versus 80%). In the procedure performed with 21 G needle, fewer samples were sufficient for the diagnosis than 22 G needle (r = 0.03, p <0.05).

Conclusion: The diagnostic accuracy rate of 21 G needle was higher than 22 G needle. According to that result, it is better to prefer 21 G needle. With a 21 G needle, a smaller number of sample was sufficient for diagnosis than a 22 G needle. Diagnostic opportunity with less sample obtained with 21 G needle may provide time advantage to the cytopathologist who performs ROSE. Due to this advantage, in EBUS TBNA with ROSE, 21 G needles can be prioritized.

Anahtar Kelimeler

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA);, Rapid On Site Evaluation (ROSE);, 21 Gauge Needle;, 22 Gauge Needle

Kaynakça

• 1. Vaidya PJ, Kate AH, Chhajed PN. Endobronchial ultrasound-guided transbronchial needle aspiration: The standard of care for evaluation of mediastinal and hilar lymphadenopathy. J Cancer Res Ther 2013; 9:549-51. doi: 10.4103/0973- 1482.126430.
• 2. Herth F, Becker HD, Ernst A. Conventional vs endobronchial ultrasound-guided transbronchial needle aspiration: a randomized trial. Chest 2004;(125):322-5. PMID: 14718460
• 3. Yasufuku K, Chiyo M, Sekine Y, et al. Real-time endobronchial ultrasound-guided transbronchial needle aspiration of mediastinal and hilar lymph nodes. Chest. 2004; 126:122–128. PMID: 15249452
• 4. Alsharif M, Andrade RS, Groth SS, Stelow EB, Pambuccian SE. Endobronchial ultrasound-guided transbronchial fine-needle aspiration: The University of Minnesota experience, with emphasis on usefulness, adequacy assessment, and diagnostic difficulties. Am J Clin Pathol. 2008; 130:434–443. doi: 10.1309/BLLQF8KDHWW6MJNQ.
• 5. Feller-Kopman D, Yung RC, Burroughs F, Li QK. Cytology of endobronchial ultrasound-guided transbronchial needle aspiration: a retrospective study with histology correlation. Cancer Cytopathol. 2009; 117:482–490. doi: 10.1002/cncy.20049.
• 6. Sun W, Song K, Zervos M, et al. The diagnostic value of endobronchial ultrasound- guided needle biopsy in lung cancer and mediastinal adenopathy. Diagn Cytopathol. 2010; 38:337–342. doi: 10.1002/dc.21195.
• 7. Minai OA, Dasgupta A, Mehta AC. Transbronchial needle aspiration of central and peripheral lesions; in Bolliger CT, Mathur PN (eds): Interventional Bronchoscopy. Prog Respir. Basel, Karger,2000 pp 66-79.
• 8. Dasgupta A, Mehta AC.Transbronchial needle aspiration.Clinics in Chest Medicine.1999;20:39-51. PMID: 10205716
• 9. Schenk DA, Chambers SL, Derdak S, et al. Comparison of the Wang 19 gauge and 22 gauge needles in the mediastinal staging of lung cancer. Am Rev Respir Dis 1993;147: 1251–1258. PMID: 8484639
• 10. Wang KP, Brower R, Haponik EF, Siegelman S. Flexible transbronchial needle aspiration for staging of bronchogenic carcinoma. Chest 1983; 84:571–576. PMID: 6313305
• 11. Goldstraw P, Chansky K, Crowley J, Rami-Porta R, Asamura H, Eberhardt WE et al. The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (eighth) edition of the TNM classification for lung cancer. J Thorac Oncol. 2015;11(1):39–51. doi: 10.1016/j.jtho.2015.09.009.
• 12. Oki M, Saka H, Kitagawa C, et al. Randomized study of 21-gauge versus 22-gauge endobronchial ultrasound-guided transbronchial needle aspiration needles for sampling histology specimens. J Bronchol Intervent Pulmonology. 2011; 18 (4): 306 – 310. doi: 10.1097/LBR.0b013e318233016c.
• 13. Saji J, Kurimoto N, Morita K, et al. Comparison of 21-gauge and 22-gauge needles for endobronchial ultrasound-guided transbronchial needle aspiration of mediastinal and hilar lymph nodes. J Bronchol Intervent Pulmonology. 2011; 18 (3): 239 - 246. doi: 10.1097/LBR.0b013e3182273b41.
• 14. Lonny B. Y, Jason A, Noah L. et al. Comparison of 21-Gauge and 22-Gauge Aspiration Needle in Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration. Chest 2013; 143(4):1036–1043. doi: 10.1378/chest.12-1205.
• 15. Griffin AC, Schwartz LE, Baloch ZW. Utility of on-site evaluation of endobronchial ultrasound-guided transbronchial needle aspiration specimens. Cytojournal. 2011; 8:20. doi: 10.4103/1742-6413.90081.
• 16. Guarize J. Endobronchial ultrasound: From lung cancer diagnosis and staging to translational research. J Bras Pneumol. 2013; 39:119–20. PMID: 23670495